Even with a 167 per cent increase in its outlay, the numbers for Ayushman Bharat just don't add up

Beyond tom-tomming the benefits of Ayushman Bharat, the world’s largest public healthcare scheme, on which finance minister Piyush Goyal held forth with gusto, the healthcare sector got little in Budget 2019. No big policy shake-up, no new targets worth any mention. Attention and budget rupees were lavished, though, on the government’s flagship healthcare scheme. At Rs 6,400 crore, the Ayushman Bharat budget is a 167 per cent increase over its outlay at launch of Rs 2,400 crore. Even this ignites a firestorm of scrutiny: jumla, inadequate numbers not tallying up, its critics scream. But, then, politics is also about marketing. The main takeaway of Budget 2019 is the optics: tax breaks, sops and incentives to win headlines.

Repackaged twice, the scheme is now aligned closely to the PM: Ayushman Bharat-Pradhan Mantri Jan Swasthya Yojana or AB-PMJAY. Since January, the PM has been writing personal letters to beneficiariesalleg­edly at a cost of Rs 400 crore (including printing and speed post) to 90 mill­ion peopleinfuriating some states. Modi is sending letters to people across Bengal claiming credit, though 40 per cent of the costs came from our Swa­sthya Sathi scheme, says Mamata Banerjee, West Bengal chief minister. Kerala is equally livid. A deceitful attempt to put the financial burden on states and take credit for it, says fin­ance minister Dr Thomas Isaac. Delhi, Kerala, West Bengal, Odisha, Punjab and Telangana have now opted out of AB-PMJAY.

Question marks remain over the numbers and inadequate budgetary allocation. Healthcare coverage under Ayushman Bharat has got Rs 6,400 crore in Budget 2019. Even by NITI Aayog projections of Rs 12,000 crore per annum, it is inadequate. Actuarial calculations show a 20 times higher shortfall. The Centre needs to allocate a minimum Rs 30,000 crore per annum, says Dr Ekbal Bappukunju, neuro­surgeon, public health activist and member of the Kerala State Planning Board. Otherwise, it will end up being a poll stunt, he says.

The scheme does have its supporters. To Dr Vinod K. Paul, member, Niti Aayog, and architect of the scheme, Ayushman Bharat has ushered in monumental change. Especially for people living in isolated outposts. We screen the entire population for five lifestyle diseases at the health and wellness centres, he says.

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